刘超　王中琳

摘要 目的：觀察柴胡加龙骨牡蛎汤对脑卒中后癫痫的临床疗效，并评价其对外周血神经元特异性烯醇化酶（NSE）浓度的影响。方法：选取2015年1月至2016年9月山东中医药大学第一临床医学院收治的脑卒中后癫痫患者50例纳入研究，随机分为对照组和观察组，每组25例。2组患者均接受神经内科常规治疗，对照组在基础上加用丙戊酸钠缓释片，观察组在对照组治疗方案基础上加用柴胡加龙骨牡蛎汤，1剂/d，200 mL煎服，早晚温服分服。2组均连续治疗16周，观察治疗前后2组患者临床疗效、肢体运动功能评分（Fugl-Meyer评分及BBS评分）、癫痫发作次数、发作持续时间、脑电图指标以及NSE浓度变化。结果：1）治疗结束后观察组临床总有效率88%，与对照组68%比较，差异有统计学意义（P<0.05），观察组优于对照组。2）治疗至第4周时2组Fugl-Meyer评分和BBS评分差异无统计学意义（P>0.05），直至治疗第16周时观察组Fugl-Meyer评分、和BBS评分均优于对照组（P<0.05）；3）治疗后2组患者癫痫发作次数、发作持续时间、均较治疗前减少，其中观察组改善的幅度较对照组明显（P<0.05）；治疗至第4周时2组痫样放电、累及导联数差异无统计学意义（P>0.05），直至治疗第16周时观察组上述治疗改善明显优于对照组（P<0.05）；4）治疗至第4周时2组外周血NSE浓度差异无统计学意义（P>0.05），直至治疗第16周时观察组NSE浓度明显较对照组下降（P<0.05）。结论：柴胡加龙骨牡蛎汤对脑卒中后癫痫发作理想疗效，其作用机制可能与下调外周血NSE浓度有关。

关键词 脑卒中；癫痫；柴胡加龙骨牡蛎汤；疗效；运动功能NSE

Abstract Objective：To observe the clinical efficacy of Chaihu Jia Longgu Muli Decoction in the treatment of epilepsy resulted from cerebral apoplexy，and to evaluate the effects of peripheral blood neuron specific enolase （NSE） concentration.Methods：A total of 50 cases patients with epilepsy resulted from cerebral apoplexy treated in the First Clinical Medicine College of Shandong University of Traditional Chinese Medicine from January 2015 to September 2016 were selected and randomly divided into control group and observation group，with 25 cases in each group.Both groups received conventional treatment in neurology，and the control group was supplemented with sodium valproate sustained-release tablets.On the basis of the treatment plan of the control group，the observation group was given Chaihu Jia Longgu Muli Decoction one dose a day （200 mL decocted as one dose），and the dose was taken separately in the morning and evening with warm water.The two groups were treated for 16 weeks.The clinical efficacy，limb motor function score，seizure frequency，duration of attack，electroencephalogram and NSE concentration of both groups were observed before and after treatment.Results：After the treatment，the total clinical efficiency rate of the observation group was 88%.Compared with the rate of the control group （68%），the difference was statistically significant （P<0.05），and the rate of observation group was better than the control group.After the 4th week of treatment，there was no statistically significant difference in the Fugl-Meyer score，WOLF score and BBS score of both groups （P>0.05）.Until the 16th week of treatment，the Fugl-Meyer score，WOLF score and BBS score of observation group were better than the control group （P<0.05）.After the treatment，the frequency and duration of seizure of patients in both groups decreased，and the observation group decreased more significantly than the control group （P<0.05）.At the 4th week treatment，epileptiform discharges，involving the number of leads in both groups were no statistically significant （P>0.05），and until 16th week of treatment，the improvement of curative efficacy of observation group was better than control group （P<0.05）.There was no statistical significance of peripheral blood NSE concentration in the both groups at the 4th week （P>0.05）.Until the 16th week of treatment，the peripheral blood NSE concentration of the observation group decreased more significantly than the control group （P<0.05）.Conclusion：Chaihu Jia Longgu Muli Decoction has an effective curative effect on epilepsy resulted from cerebral apoplexy，and its mechanism may be related to the decrease of NSE concentration in peripheral blood.

Key Words Cerebral apoplexy； Epilepsy； Chaihu Jia Longgu Muli Decoction； Effect； Exercise function； NSE

中图分类号：R242；R285.6文献标识码：Adoi：10.3969/j.issn.1673-7202.2018.09.038

约有7%～8.51%[1-2]的脑卒中患者将继发癫痫，即脑卒中后癫痫（Epilepsy After Stroke，EAS）。随着脑卒中疾病人群数量的不断上调，EAS的发病率亦逐年增加，其导致神经缺损进一步损伤，严重阻碍脑卒中患者的康复进程。抗癫痫药物虽可在一定程度上控制病情的发展，但其不良反应大严重影响用药依从性。中医古籍并无EAS的病名记载，其属于“痫病”

范畴，与风火痰瘀4个因素密不可分，正如清代何梦瑶《医碥》所言：“抽搐者，证属风火”[3-4]。……